The impact of an automatic syringe dispensing machine in inner-city Sydney, Australia: No evidence of a 'honey-pot' effect

INTRODUCTION AND AIMS:

Needle and syringe automatic dispensing machines (ADM) aim to increase needle/syringe distribution to people who inject drugs. ADM implementation has been met with community concern about potential perceived increases in crime and drug use and that they will attract non-resident drug users-the 'honey-pot effect'. In April 2013, an ADM commenced operation in inner-city Sydney. We assessed the impact of the ADM on crime and examined its use by non-resident drug users (the honey-pot effect).

DESIGN AND METHODS:

Fixed-site needle and syringe program (n = 207) and ADM clients (n = 55) were surveyed to determine whether they lived within 1 km of the ADM. Police-recorded offences between January 2012 and March 2014 across six crime categories for the local and surrounding areas were assessed for trend to measure impact on crime.

RESULTS:

The majority (78%) of needle and syringe program clients reported residing within 1 km of the service. Most (95%) ADM users were fixed-site service clients. The 2 year trend for crime categories remained stable or decreased, except for fraud, which increased significantly (P < 0.05).

DISCUSSION AND CONCLUSION:

Automatic dispensing machine users were largely clients of the existing fixed-site service and lived locally. There was no apparent concurrent increase in crime or a honey-pot effect. It is important that services continue to be aware of community concerns and respond to them appropriate

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By:  Grau LE1, Zhan W1,2, Heimer R1.

• 1Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.
• 2Department of Children and Families, Hartford, USA. 
• Drug Alcohol Rev. 2016 Apr 13. doi: 10.1111/dar.12396

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Sharing of Needles and Syringes among Men Who Inject Drugs: HIV Risk in Northwest Bangladesh

INTRODUCTION:

Injection drug use is prevalent in northwestern Bangladesh. We sought to explore the context of needle/syringe sharing among persons who inject drugs (PWID), examining risk exposures to blood-borne infections like the human immunodeficiency virus (HIV) and hepatitis in a region where these dual epidemics are likely to expand.

METHODS:

We used a qualitative research approach to learn about injection practices, conducting 60 in-depth interviews among PWID. We then conducted 12 focus group discussions (FGDs) that generated a checklist of salient issues, and followed up with personal observations of typical days at the drug-use venues. Content and interpretative frameworks were used to analyze qualitative information and socio-demographic information, using SPSS software.

RESULTS:

We found that needle/syringe-sharing behaviours were integrated into the overall social and cultural lives of drug users. Sharing behaviours were an central component of PWID social organization. Sharing was perceived as an inherent element within reciprocal relationships, and sharing was tied to beliefs about drug effects, economic adversity, and harassment due to their drug user status. Carrying used needles/syringes to drug-use venues was deemed essential since user-unfriendly needle-syringe distribution schedules of harm reduction programmes made it difficult to access clean needles/syringes in off-hours. PWID had low self-esteem. Unequal power relationships were reported between the field workers of harm reduction programmes and PWID. Field workers expressed anti-PWID bias and judgmental attitudes, and also had had misconceptions about HIV and hepatitis transmission. PWID were especially disturbed that no assistance was forthcoming from risk reduction programme staff when drug users manifested withdrawal symptoms.

CONCLUSION:

Interventions must take social context into account when scaling up programmes in diverse settings. The social organization of PWID include values that foster needle-syringe sharing. Utilization and impact of risk reduction programmes might be improved with expanded clean needle/syringe distribution at times and venues convenient for PWID, better trained and non-judgmental staff, and medical assistance for health problems, including drug withdrawal symptoms.

Below:  Socio-demographic profile for 140 persons who inject drugs in Rajshani, Bangladesh

Full article at:   http://goo.gl/OBTdZE

By:  Pasa MK1, Alom KR1, Bashri Z2, Vermund SH3.

• 1Department of Anthropology, University of Rajshahi, Rajshani, Bangladesh.
• 2Institute of Environmental Science, University of Rajshahi, Rajshani, Bangladesh.
• 3Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America. 

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New Cases of HIV among People Who Inject Drugs in Hungary: False Alarm or Early Warning?

Between 2009 and the first quarter of 2014, only one case of HIV (contracted outside Hungary) was detected among PWIDs in Hungary. However, more recent evidence suggests increased sharing of injecting paraphernalia among PWIDs. This is linked to the emergence of new designer drugs that require frequent injection, alongside funding cuts to the Hungarian needle exchange program (NEP) which has reduced access to sterile injecting equipment. 

During the past five years in Hungary, drug use has become increasingly discussed in moral as opposed to public health terms, and drug consumption has been re-criminalized. The largest NEP in Hungary was closed because of political pressure and government funding for regular HCV/HIV testing/counselling and seroprevalence studies among PWIDs has been stopped. T

his paper describes the detection of two new cases of HIV infection in PWIDs attending two NEPs in Budapest in May 2014. These new cases may indicate an unfolding HIV outbreak among PWIDs-similar to those reported in Greece and Romania. 

Yet the question remains: If no further HIV cases are detected, is this because there are no new cases or because there are no testing facilities for PWID?

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By:  Rácz J1, Gyarmathy VA2, Csák R3.

• 1Eötvös Loránd University, Institute of Psychology, Budapest, Hungary; Semmelweis University, Faculty of Health Sciences, Budapest, Hungary; Blue Point Drug Counselling and Outpatient Centre, Budapest, Hungary.
• 2Semmelweis University, Faculty of Health Sciences, Budapest, Hungary; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: vgyarmat@jhsph.edu.
• 3Semmelweis University, Faculty of Health Sciences, Budapest, Hungary; Blue Point Drug Counselling and Outpatient Centre, Budapest, Hungary. 

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Changing How We Think About Syringe Exchanges

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Health Behaviors of Young Adult Heroin Injectors in the Seattle Area

Highlights

• Younger heroin injectors engage in risky injection practices more than older heroin injectors.
• Younger heroin injectors re-use syringes and share syringes more than older heroin injectors.
• Younger heroin injectors are much less likely to report having tested positive for hepatitis C.
• Outreach and medical screening and care should address young adult injectors’ needs.

Abstract

Background

Recent indicators point to substantial increases in the number of young heroin users across much of the United States as well as across Washington State. This study characterizes this younger generation of heroin injectors in order to inform public health responses.

Methods

A cross-sectional analysis was conducted using street-intercept surveys at King County, WA syringe exchange programs in 2013. Survey responses were restricted to heroin injectors (n = 389) and then categorized by the participant's age (<30 and ≥30) for a descriptive epidemiological analysis. A manual stepwise logistic regression tested the independent relationship of user characteristics with being under the age of 30.

Results

In regression analyses, adjusting for other characteristics, young adults were significantly (p < 0.05) more likely to: re-use syringes 2–4 times (OR = 2.28 compared to those who used a syringe once), share syringes (OR = 2.92), report they were “hooked on” prescription-type opioids prior to using heroin (OR = 2.54), have had a sexual partner in the prior year (opposite sex OR = 7.37, same sex OR = 23.29, both genders OR = 22.04), and report powder cocaine use in the prior 3 months (OR = 2.49) compared to those ages 30 and older. Young adults were significantly less likely to report using pain medicines (OR = 0.33), having an abscess in the prior year (OR = 0.33) or having tested positive for hepatitis C (OR = 0.22) than older adults adjusting for other variables.

Conclusions

Younger heroin injectors engage in risky injection practices more than older heroin injectors. Along with other significant differences, these findings have implications for outreach programs and medical care for younger heroin injectors.

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By:  Emily R. Cedarbaum, Caleb J. Banta-Green

Affiliations

• Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St, Suite 120, Seattle, WA 98105-4631, United States

Correspondence

• Corresponding author. Tel.: +1 206 685 3919; fax: +1 206 543 5473.

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Self-Perceived Weight and Anabolic Steroid Misuse among US Adolescent Boys

Purpose

Anabolic steroid misuse is a growing concern among adolescent boys, and chronic misuse is associated with multisystemic health consequences. However, little is known about weight related predictors of anabolic steroid misuse. We examined the prediction of lifetime anabolic steroid misuse as a function of self-perceived weight status among US adolescent boys.

Methods

Analysis was undertaken using the 2013 Youth Risk Behavior Survey, a nationally representative data set sampling public and private high school students throughout the United States. Data from a total of 6,000 US adolescent boys were used in the present study.

Results

The prevalence of ever misusing anabolic androgenic steroids was 12.6% among boys who viewed themselves as very underweight, 11.9% for boys who viewed themselves as very overweight, compared with 3.8% for boys who viewed themselves as about the right weight. Compared to boys who viewed themselves as about the right weight, boys who self-perceived themselves as very underweight (adjusted odds ratio = 6.9, 95% confidence interval: 2.7–17.7, p < .001) and very overweight (adjusted odds ratio = 3.8, 95% confidence interval: 1.8–7.7, p < .001) were significantly associated with increased risk of anabolic androgenic steroid misuse.

Conclusions

Large effect size estimates were revealed, suggesting that anabolic androgenic steroid misuse is not solely a function of boys desiring increased mass; boys who desire leanness are also likely to misuse anabolic androgenic steroids. Future prevention efforts should target not only boys who view themselves as underweight but also those who perceive themselves as overweight.

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By:  Jonathan D. Jampel,  Stuart B. Murray, Ph.D., Scott Griffiths, Aaron J. Blashill, Ph.D.

Affiliations

Department of Psychology, San Diego State University, San Diego, California

Department of Psychology, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California

Correspondence

Address correspondence to: Aaron J. Blashill, Ph.D., Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA 92120.

 

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A Study on the Risk & Its Determinants of HIV Transmission by Syringe Sharing among HIV-Positive Drug Users

OBJECTIVE:

To understand the risks and associated factors of HIV transmission by sharing syringes among HIV-positive drug users.

METHOD:

The survey was conducted among HIV-positive injecting drug users (IDUs-HIV+) who received HIV counseling, testing and treatment in Changsha city Infectious Disease Hospital and Hengyang city No.3 People's Hospital from July 2012 to May 2013 to understand their socio-demographic characteristics, HIV prevalence and syringe sharing. A total of 503 IDUs-HIV+ were involved in and provided the contact list of 2 460 drug users who had the syringe sharing experience over one month with IDUs-HIV+. 420 IDUs-HIV+ among 503 were defined as infection sources due to sharing syringe with at least one drug user. Among them, 234 HIV-negative persons were in control group, and 186 HIV-positive were in cased group. A total of 1 220 drug users were followed up among 2 460 and defined as vulnerable population. The HIV transmission rate was calculated based on the HIV prevalence among vulnerable population. Based on the result of HIV transmission to vulnerable population from 420 infection sources, case-control study and the multivariate logistic regression analysis were adopted to explore the associated factors of HIV transmission among IDUs-HIV+.

RESULTS:

As the sources of HIV transmission, 420 IDUs-HIV+ had an average duration of (4.5 ± 1.2) years for drug use. As a susceptible population, 1 220 drug users sharing syringes with the 420 IDUs-HIV+ had an average duration of (1.1 ± 0.5) years for drug use. There were 238 HIV-positive persons among 1 220 vulnerable drug users, with a transmission rate of 0.57. In the case-control study, the proportion of male subjects was 87.1% (162/186) in the case group, which was higher than that in the control group (77.8%, 182/234). The proportion of subjects who received support after knowing their HIV infection status was 51.1% (95/186) in the case group, which was lower than that in the control group (79.5%, 186/234). The proportion of subjects sharing syringes every time of using drugs was 47.8% (89/186) in the case group, which was higher than that in the control group (36.8%, 86/234). The proportion of subjects having AIDS awareness was 21.0% (39/186) in the case group, which was lower than that in the control group (64.5%, 151/234); the proportion of subjects having close contact with HIV-positive persons for more than 106 days was 60.2% (112/186) in the case group, which was higher than that in the control group (31.6%, 74/234). The proportion of subjects maintaining the original drug use method after being infected with HIV was 50.5% (94/186) in the case group, which was higher than that in the control group (16.7%, 39/234) (all P values < 0.05). The multivariate logistic regression analysis was carried out to analyse high correlate factors of HIV transmission by sources of transmission, and the AIDS awareness, duration of contact between sources of transmission and vulnerable population, access to support following confirmed HIV infection were protective factors, OR (95% CI) values were 0.155 (0.104-0.262), 0.170 (0.106-0.253), and 0.306 (0.189-0.450), respectively; while the frequency of syringe sharing and continuous drug use after being infected with HIV were risk factors, and the OR (95% CI) values were 3.06 (1.77-5.29), and 3.54 (2.16-5.80), respectively.

CONCLUSION:

HIV transmission by IDUs-HIV+ might be contained by raising AIDS awareness, providing comprehensive psychological support, conducting needle exchange and methadone maintenance treatment and reducing syringe sharing.

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By:  Bao Y1, Zhang Y, Liang Y, Chen M, Sun J, Tan H2.

• 1Department of Epidemiology and Biostatistics, School of Public Health, Central South University, Changsha 410008, China.
• 2Email: tanhz99@qq.com.

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The Effect of On-Site & Outreach-Based Needle & Syringe Programs in People Who Inject Drugs in Kermanshah, Iran

Highlights

• Outreach needle and syringe program (NSP) model is as effective as facility-based NSP in reducing the harm associated with drug injection.
• The outreach model is even more effective in reducing the lending of syringes.
• Both NSP models increase the rate of HIV testing.
• We found that less than one-quarter of people who inject drugs have access to NSP services through outreach services, which need to be scaled up.

Abstract

Background

Needle and syringe programs (NSP) are widely used to reduce harms associated with drug injection. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach NSP model on injection risk behaviours.

Methods

We used self-reported data from 455 people who inject drugs (PWID) during 2104 in Kermanshah, Iran to measure demographic characteristics and risk behaviors. We also used both self-reported and program data to identify their main source of injection equipments. Accordingly, we grouped participants into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Using coarsened exact matching, we made the three groups statistically equivalent based on age, place of residence, education and income; and compared them regarding the proportion of borrowing or lending syringes/cookers, reusing syringes and recent HIV testing.

Results

Overall, 76% of participants reported any NSP service use during the two months prior to the interview. Only 23% (95%CI: 17-27) reported the outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI 0.10-0.70), recent syringe reuse (OR 0.38, 95%CI 0.23-0.68) and increased recent HIV testing (OR 2.60, 95%CI 1.48-4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI 0.15-0.60), while facility-based did not (OR: 1.25, 95%CI 0.74-2.17).

Conclusion

We found that outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and in increasing the rate of HIV testing. The outreach model is even more effective in reducing the lending of syringes to other PWID in compare to facility-based NSP model. Scaling up outreach NSP is an effective intervention to further reduces the transmission of HIV via needle sharing.

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By:  Mehdi Noroozi, Hamid Soori, Alireza Noroozi, Seyed Saeed Hashemi Nazari, Yadoallah Mehrabi, Ahmad Hajebi, Hamid Sharifi, Peter Higgs, Ali Mirzazadeh

Affiliations

Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Global Health Sciences, University of California, San Francisco, CA, USA

Correspondence

Corresponding author.at: 550 - 16th Street, 3rd F, San Francisco CA 94158 Tel.: +415 476 5821.

 

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Emergence of Methadone as a Street Drug in St. Petersburg, Russia

BACKGROUND:

The syndemic of opioid addiction, HIV, hepatitis, tuberculosis, imprisonment, and overdose in Russia has been worsened by the illegality of opioid substitution therapy. As part of on-going serial studies, we sought to explore the influence of opioid availability on aspects of the syndemic as it has affected the city of St. Petersburg.

METHODS:

We employed a sequential approach in which quantitative data collection and statistical analysis were followed by a qualitative phase. Quantitative data were obtained in 2013-2014 from a respondent-driven sample (RDS) of people who inject drugs (PWID). Individuals recruited by RDS were tested for antibodies to HIV and interviewed about drug use and injection practices, sociodemographics, health status, and access to medical care. Subsequently, we collected in-depth qualitative data on methadone use, knowledge, and market availability from PWID recruited at nine different locations within St. Petersburg.

RESULTS:

Analysis of interview data from the sample revealed the percentage of PWID injecting methadone in the 30 days prior to interview increased from 3.6% in 2010 to 53.3% in 2012-2013. Injection of only methadone, as compared to injecting only heroin or both drugs, was associated with less frequent injection and reduced HIV-related injected risk, especially a lower rate of injecting with a previously used syringe. In-depth questioning of methadone injectors corroborated the finding from serial quantitative surveys of PWID that methadone's black market availability is a recent phenomenon. Spatial analysis revealed widespread methadone availability but no concentration in any specific districts of the city.

CONCLUSION:

Despite the prohibition of substitution therapy and demonization of methadone, the drug has emerged to rival heroin as the most commonly available opioid in St. Petersburg. Ironically, its use is associated with reduced injection-related HIV risk even when its use is illegal.

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By:  Heimer R1, Lyubimova A2, Barbour R3, Levina OS2.

• 1Center for Interdisciplinary Research on AIDS and Department of the Epidemiology of Microbial Disease, Yale University School of Public Health, New Haven, CT, USA. Electronic address: robert.heimer@yale.edu.
• 2NGOStellit, St. Petersburg, Russia.
• 3Center for Interdisciplinary Research on AIDS and Department of the Epidemiology of Microbial Disease, Yale University School of Public Health, New Haven, CT, USA 

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Number of Syringes Distributed per People Who Inject Drugs per Year in Selected Countries

Via:  http://goo.gl/YOKLbF By: https://twitter.com/avert_org

Effect of Legal Status of Pharmacy Syringe Sales on Syringe Purchases by Persons Who Inject Drugs in San Francisco & San Diego, CA

Sharing blood-contaminated syringes is the main risk factor for acquiring and transmitting blood-borne infections among persons who inject drugs (PWID). To reduce this risk, in 2005, California enacted legislation allowing local health jurisdictions to legalize non-prescription syringe sales after approving a disease prevention demonstration project (DPDP). With San Francisco approving a DPDP immediately and San Diego never approving one, we compared PWID across cities for their use of pharmacies PWID to obtain syringes.

PWID age 18-30 years old were recruited into separate studies in San Francisco (n=243) and San Diego (n=338) between 2008 and 2011. We used multivariable logistic regression to compare the proportions of PWID who obtained syringes from pharmacies by city while controlling for sociodemographics, injection practices and other risk behaviors.

Overall, most PWID were White (71%), male (63%), and between the ages of 18-25 years (55%). Compared to San Francisco, a smaller proportion of PWID in San Diego had bought syringes from pharmacies in the prior three months (16.9% vs. 49.8%; p<0.001), which remained statistically significant after adjusting for sociodemographic and behavioral factors (adjusted odds ratio=4.45, 95% confidence interval: 2.98, 6.65).

Use of pharmacies to obtain syringes was greater where it was legal to do so. Public health policy can influence HIV and hepatitis C associated risk among PWID; however, implementation of these policies is crucial for the benefits to be realized.

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By: Siddiqui SS1, Armenta RF2, Evans JL3, Yu M3, Cuevas-Mota J2, Page K3, Davidson P2, Garfein RS4.

• 1Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
• 2Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
• 3Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
• 4Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA. Electronic address: rgarfein@ucsd.edu.  

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Syringe Confiscation as an HIV Risk Factor: The Public Health Implications of Arbitrary Policing in Tijuana and Ciudad Juarez, Mexico

Female sex workers who inject drugs (FSW-IDUs) face elevated risk for HIV/STIs and constitute a key population for public health prevention. Through direct and indirect pathways including human rights violations, policing practices like syringe confiscation can compound FSW-IDU health risk and facilitate the spread of disease. 

We studied correlates of experiencing syringe confiscation among FSW-IDUs in northern Mexico, where formal policy allows for syringes to be available over the counter without a prescription, but police practices are often at odds with the law. FSW-IDUs reporting recent syringe sharing and unprotected sex with clients in Tijuana and Ciudad Juarez were administered surveys and HIV/STI testing. Logistic regression was used to identify correlates of syringe confiscation. 

Among 624 respondent FSW-IDUs, prevalence of syringe confiscation in the last 6 months was 48 %. The following factors were positively associated with syringe confiscation: testing positive for HIV (adjusted odds ratio [aOR] = 2.54, 95 % confidence interval [CI] = 1.11–5.80), reporting sexual abuse by police (aOR = 12.76, 95 % CI = 6.58–24.72), engaging in groin injection (aOR = 1.84, 95 % CI = 1.15–2.93), injecting in public (aOR = 1.64; 95 % CI = 1.14–2.36), and obtaining syringes from pharmacies (aOR = 1.54; 95 % CI = 1.06–2.23). Higher education level was negatively associated with syringe confiscation (aOR = 0.92, 95 % CI = 0.87–0.98) as was frequent injection with clients within the last month (aOR = 0.64, 95 % CI = 0.44–0.94). 

This analysis adds to the body of evidence linking unauthorized law enforcement actions targeting high-risk groups with HIV and other adverse health outcomes. Using a public health lens to conceptualize abuse as a structural risk factor, we advocate for multi-prong prevention, systematic monitoring, and evidence-based intervention response to deleterious police practices.

Table 1

Descriptive statistics by syringe confiscation by police (during the previous 6 months) (N = 624)

Variable	Had syringe confiscated by police (n = 301)	Did not have syringe confiscated by police (n = 323)	Total (n = 624)	P
Interview location
Tijuana	118 (39.2 %)	194 (60.1 %)	312 (50.0 %)	<.001
Ciudad Juárez	183 (60.8 %)	129 (39.9 %)	312 (50.0 %)
Sociodemographics
Age, median (IQR)	32 (27–39)	34 (28–41)	33 (27–40)	.18
Lived in the city of interview for the entire life	142 (47.2 %)	131 (40.6 %)	273 (43.8 %)	.11
Married	119 (39.5 %)	117 (36.2 %)	236 (37.8 %)	.41
Number of years of education completed, median (IQR)	6 (4–8)	7 (5–9)	6 (5–9)	<.001
Speaks English	71 (23.6 %)	94 (29.1 %)	165 (26.4 %)	.12
Financially responsible for children	129 (42.9 %)	133 (41.2 %)	262 (42.0 %)	.67
Injection and sexual risk behavior
Age when first injected drugs, median (IQR)	19 (16–24)	20 (17–27)	20 (17–25)	<.001
Age when first traded sex for money, median (IQR)	18 (15–20.5)	19.5 (16–25)	19 (15–23)	<.001
First drug used: meth	5 (1.9 %)	25 (9.0 %)	30 (5.6 %)	<.001
Receptive syringe sharing (half of the time or more)a	171 (57.0 %)	190 (58.8 %)	361 (57.9 %)	.68
Normally injected drugs in public placesa	201 (66.8 %)	173 (53.6 %)	374 (59.9 %)	<.001
Duration (years) of injection, median (IQR)	12 (5–18)	11 (4–18)	11 (5–18)	.09
Groin injectiona	65 (21.6 %)	40 (12.4 %)	105 (16.9 %)	.003
Sought the help of a hit doctora	123 (40.9 %)	121 (37.5 %)	244 (39.1 %)	.41
Number of people usually injected with, median (IQR)a	4 (2–7)	2 (1–5)	3 (1–5)	. < 001
Number of male clients, median (IQR)a	40 (15–90)	24 (10–56)	30 (10–80)	<.001
Ratio of unprotected/total number of sex acts with clients, median (IQR)a	0.34 (0.00–0.68)	0.00 (0.00–0.45)	0.15 (0.00–0.56)	<.001
Total number of unprotected vaginal and/or anal sex acts, median (IQR)a	23 (2–62)	6 (0–32)	13.5 (0–45)	<.001
Health and psychological assessment
HIV infection, based on confirmatory positive test result	22 (7.3 %)	12 (3.7 %)	34 (5.5 %)	.05
Syphilis infection (based on titer > =1:8)	29 (9.8 %)	35 (11 %)	64 (10.4 %)	.69
Any STI, based on confirmatory test results (excluding BV)	186 (61.8 %)	175 (54.2 %)	361 (57.9 %)	.06
Self-esteem (Rosenberg Score), median (IQR)	2.38 (2.13–2.50)	2.5 (2.25–2.5)	2.46 (2.25–2.5)	.60
Depression (CES-D score of 10 = depression), median (IQR)	12 (6–17)	12 (7–18)	12 (7–18)	.14
Physical, social, and economic risk environment
Number of hours spent on the streets, on typical day, median (IQR)b	11.5 (8–16)	10 (7–15)	10 (7–15)	.07
Spouse/steady partner ever injected illegal drugs, among those with spouse	89 (69.5 %)	74 (63.2 %)	163 (66.5 %)	.34
Income (in US dollars) earned from sex, median (IQR)a	1,056.5 (405–1,915)	820 (380–1,525)	935 (400–1,800)	.02
Often/always injected drugs with a client arounda	88 (29.2 %)	120 (37.2 %)	208 (33.3 %)	.04
Worked as a prostitute in the streeta	244 (81.3 %)	256 (79.5 %)	500 (80.4 %)	.61
Worked as a prostitute in hotel or motela	68 (22.7 %)	75 (23.3 %)	143 (23.0 %)	.92
Service utilization
Ever had an HIV test	171 (57.0 %)	152 (47.1 %)	323 (51.8 %)	.02
Ever had a gynecological checkup	58 (19.3 %)	61 (19.1 %)	119 (19.2 %)	1.0
Ever received methadone or buprenorphine treatment (among heroin users)	61 (20.5 %)	63 (20.1 %)	124 (20.3 %)	.92
Obtained syringes from pharmacya	197 (65.7 %)	182 (56.3 %)	379 (60.8 %)	.02
Obtained syringes from syringe exchange programa	39 (13.0 %)	28 (8.7 %)	67 (10.8 %)	.09
Experiences with police
Ever been arrested	284 (94.4 %)	186 (57.6 %)	470 (75.3 %)	<.001
Police officer has asked you for sexual favorsb	154 (51.2 %)	49 (15.2 %)	203 (32.5 %)	<.001
Sexually abused by a police officerb	94 (31.2 %)	12 (3.7 %)	106 (17.0 %)	<.001
Police officer has asked you for moneyb	273 (90.7 %)	111 (34.4 %)	384 (61.5 %)	<.001
Police officer has forcibly taken your moneyb	213 (70.8 %)	55 (17.0 %)	268 (42.9 %)	<.001

aLast month

bPast 6 months

Table 3

Multivariate analysis of factors associated with syringe confiscation among FSW-IDUs in Tijuana and Ciudad Juarez (N = 621)

Predictor	Adjusted odds ratio estimate	Lower 95 % confidence limit	Upper 95 % confidence limit
Sexually abused by a police officera	12.76	6.58	24.72
HIV infection, based on confirmatory positive test result	2.54	1.11	5.80
Groin injectionb	1.84	1.15	2.93
Normally injected in public spacesb	1.64	1.14	2.36
Obtained syringes from pharmacyb	1.54	1.06	2.23
Years of education completed (per year)	0.92	0.87	0.98
Often/always injected drugs with a client aroundb	0.64	0.44	0.94

aPast 6 months

bPast month

Full article at: http://goo.gl/TQ43gX

By:  Beletsky L1, Lozada R, Gaines T, Abramovitz D, Staines H, Vera A, Rangel G, Arredondo J, Strathdee SA.

1Division of Global Public Health, University of California-San Diego, La Jolla, CA, USA.

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